Wessington Springs, South Dakota
Week 1

Monday: After meeting the physicians, we jumped right in as we shadowed in the clinic. In medical school we have had a number of preceptor experiences so the experience seemed fairly comfortable. For lunch we were treated to a nice meal at a hospital meeting followed by more shadowing in the clinic.

Tuesday: After the usual patient report at 8:15 am we rounded with one of the physicians in the hospital. I found it very interesting to see first-hand how the eEmergency system works during an ER patient case. My background in a bigger emergency department has given me an interest in that area and it was remarkable to see firsthand the technology that I had only read about. We had lunch at the local café in a meeting with the community club. It was impressive to see the strong community ties and commitment these members have to their small community. After lunch we drove down to Plankinton to spend the afternoon at the weekly clinic at Aurora Plains Academy. While our time there was brief, I left feeling encouraged that there was a facility to help some of South Dakota’s more troubled youth.

Wednesday: We had a meeting with the marketing director first thing after patient report and hospital rounds today. She was excited to hear about some of the ideas that Trent and I had come up with for our community projects. I’m sure I will be blogging about them more as they develop. We were treated to lunch again at another hospital board meeting. At the meeting we were asked to give our insight as professional healthcare students. Naturally, they were interested to know what they can do to attract more health professionals to their community. Afterwards, we spent the rest of the day in the clinic.

Thursday: I was scheduled for a half day in the clinic today with the afternoon off for us to work on our projects. In the afternoon we hiked one of the trails in Wessington Springs. There were a number of informative signs along the trail that explained some of the history of Wessington Springs that we found very interesting. For supper we went to a local bar and grill and had some exceptionally delicious burgers while we watched the second game of the NBA Finals. I have a feeling we will be visiting that establishment again.

Friday: Another morning in the clinic. This was my first time following Dr. Lim. He shared a number of “horror stories” detailing the difficulties of establishing a career in the United States after graduating from a foreign medical school. I will most likely be sharing these stories with my fellow classmates on days when we complain about the challenges of our US medical school. Since Dr. Lim was the only doctor in the clinic today, he gave me the afternoon off after we had seen all the scheduled patients. This was readily accepted since I was feeling fairly exhausted from our very busy week.

Week 2
Monday: After the morning patient report and rounding in the hospital, I followed Dr. Dean in the clinic. I got the chance to discuss some of the difficulties of providing the best quality care to an elderly community in rural South Dakota. As it applied to one of our cases, I observed some of the challenges of transitioning from independent living to a more assisted environment.

Tuesday: Today I spent the morning with Dr. Lim in the clinic seeing patients. We attended the weekly Springs Area Community Club meeting over lunch which was a nice treat again. In the afternoon I accompanied Dr. Dean to the satellite clinic in Woonsocket where we saw a few patients. It was interesting to see how the rural community maximizes the small number of family physicians it has by forming a network of small clinics that are open on certain days of the week.

Wednesday: This morning after patient report, I followed Terri Groves, PA-C, in the clinic. I then followed Dr. Orstad in the afternoon. Between Terri and Dr. Orstad, they see many of the community’s younger and/or female patients. This was a fresh change from a lot of the geriatric patients I had been seeing.

Friday: Today, both Trent and I were in the clinic. I spent the morning following Dr. Orstad. She had a couple of her early patients cancel so I got a little time to read some of her medical journals. Over lunch, we got a driving tour of Wessington Springs from the marketing director here at the hospital. She knew a lot about the town’s history and it was very informative. We also got a chance to see the locations where we had decided to do our community projects. In the afternoon, I followed Dr. Lim in the clinic. He had a light schedule and he let me go early since it was Friday. We did have an ER patient later that afternoon which showed the textbook presentation of an appendicitis which is what it turned out to be. While it was very easy, it felt good to nail the diagnosis in the ER.

Saturday: Trent and I had our first of three community service projects today. We had a blood pressure screening at an assisted living center. This weekend there was an all-school reunion in town and we felt blood pressure screening would coincide well with that. We screen several individuals and it was nice to interact with the people in the community and those that had traveled across the country for the reunion. Everyone was very friendly and appreciative.

Week 3
Monday: Today was the day of the month that Dr. Leland, a general surgeon, comes to Wessington Springs. We were able to spend the morning in his surgical cases which was particularly interesting since much of our time has been spent in the clinical setting. While all the cases were typical scope procedures, we enjoyed putting on the scrubs and being in the operating room. In the afternoon, Trent and I were back in the clinic seeing patients with Dr. Dean and Dr. Orstad.

Tuesday: After morning rounds I was with Dr. Dean in the clinic until about noon. Fortunately, there was a scheduling error and Dr. Lim was also in the clinic today so I was able to follow him in the afternoon. Trent and I attended our last Springs Area Community Club meeting for lunch. In our two weeks of being here thus far, we are starting to recognize some of the faces out in the community that we have been seeing in the clinic. I think that interacting with patients outside of the clinical setting helps build stronger physician-patient relationships and is something that I will find to be an enjoyable part of my practice.

Wednesday: This morning, after rounds, it was my turn to go work in the local pharmacy. Thornton Drug in the only pharmacy in Wessington Springs and, as such, it services almost all the patients that we have been seeing in the clinic. This was also my first experience in a pharmacy so it was interesting to see the specifics of how things are done. The pharmacist even had me fill a few prescriptions. This was fairly uncomfortable because I really didn’t want to mess up and I felt she should have been watching me closer. But no mistakes were made and everything was great. After lunch we heard a brief presentation on Medicare and healthcare reform from Dr. Dean, who is very active in the process as a member of Med-PAC. We then had the rest of the afternoon off to fine tune our projects.

Thursday: Today we presented a display about West Nile Virus at the local baseball game as our second community project. Along with that, we had bug spray and some free stuff people could sign up to win if they stopped by our table. The weather was very nice and it made for a pleasant evening to be outside.

Friday: After the morning nurse’s report, I was with Dr. Lim for the day. The schedule was fairly busy which helped keep things moving along. Dr. Lim drained a swollen knee and had a couple steroid injections which were interesting to see. By the afternoon, things had settled down and he let me go early telling me to go take a nap since we were so busy that morning.

Saturday: Today we had our last community project at the pool. Trent and I had a display about sun safety which talked about the importance of sunscreen and how the sun’s UV rays can be very damaging to your skin and increase your chances of skin cancer. We had sunscreen available for anyone who needed some and several ice pops for people who stopped by our display.

Week 4
Monday: Today was another very busy day in the clinic with Dr. Orstad. We did have a number of simple procedures today, some of which were steroid injections to alleviate pain in joints and limb tissue. One of the things that medical students consider when they think about specialties is if they will get bored doing them after 15-20 years. After spending this extended time in the family practice clinic and seeing how many different things they work with, I am convinced family medicine will not be a “boring” avenue of medicine. There are so many different age groups and demographics with an endless possibility of diagnoses that it seems like one would always have to be on their toes.

Tuesday: This was the day of our community presentation. Part of our requirements in the REHPS program is to present a brief presentation of what we did. A few members of the community and our REHPS supervisor were in attendance for the event. Trent and I are fairly easy-going and creative people and we didn’t want our presentation to be simply a list of things we did. We made a comical list of things we learned from our rural experience and combined it with some of the real gems that we discovered about the healthcare setting and about ourselves. I think there was plenty of laughter all around and everyone had a good time.

Wednesday: Today was the 4th of July and we got the day off. I spent my time at Lake Okoboji. Luckily I did not witness any healthcare complications.

Thursday: Dr. Dean was the only one in the clinic today. I enjoyed following him one last time. Between clinic patients, we had yet another good dialogue on the future of healthcare and how it will impact our futures as physicians. We also had a couple of knee injections. It’s always good to get as much exposure to procedures as possible. At this point, I have seen so many knee injections that I feel confident I could try one… under supervision, of course.

Friday: Today is our last day. As I reflect back on our time in Wessington Springs I think about how much of a positive experience it was. We were able to see a time-lapse picture of how the family practice clinic functions, something that is difficult to accomplish on the morning preceptorships that we have in medical school. Just as important is the enjoyment I had in the rural community. Making those small-town connections and offering a helping hand to your neighbor, who lives in close proximity to you, is something I find very rewarding as I plan for my future practice. I feel very blessed to have been able to spend time in the rural healthcare setting through the REHPS program.